primacare

• Primary eye care


  Vital component of primary health care: Promotion of eye health, prevention, and treatment of conditions leading to visual loss

  
• Primary health care (PHC) concept introduced in Alma-Ata


  1978
• Primary eye care


  • Change the pattern of eye care services from centralized hospitals and city-based eye units to nationwide blindness prevention programs
• PHC elements related to primary eye care


  • Safe water
  • Basic sanitation
  • Maternal/childcare, Family planning
  • Immunization
  • Control of locally endemic disease (Trachoma control)
  • Health and nutrition education
  • Treatment of common diseases
  • Provision of essential drugs
• Trachoma


  Neglected tropical disease characterized by preventable, blindness caused by Chlamydia trachomatis, a common bacteria associated with sexually transmitted infections
• 5 stages of trachoma


  • Trachomatous Follicular Inflammation (TF)
  • Trachomatous Intense Inflammation (TI)
  • Trachomatous Scarring (TS)
  • Trachomatous Trichiasis (TT)
  • Corneal Opacity
• Groups affected by trachoma


  • Children
  • Lactating Moms
  • Pregnant woman
• Aim to incorporate red, orange, or yellow fruits or vegetables into your daily diet
• Consult your doctor if you suspect you or your child may be deficient in vitamin A
• Night blindness


  Inability to see well at night or in poor light conditions while maintaining normal vision during daylight
• Vitamin A deficiency is a leading cause of blindness in children
• Vitamin A deficiency increases the risk of disease and death from infections, respiratory diseases, diarrhea, and cancer
• Benefits of eating vitamin A foods


  A healthier eye and better eyesight contribute to a strong immune system and promote healthy and happy child development
• Comprehensive eye care


  Encompasses a range of activities, including promoting eye health, preventing diseases, providing curative measures during illness, and offering rehabilitation for damage caused by diseases
• Components of comprehensive eye care


  • Promotive
  • Preventive
  • Curative
  • Rehabilitative
  • Universality (All groups, cast, religion)
  • Available (Range of services)
  • Affordable (cost and price)
  • Acceptable (Meets needs)
  • Accessible (Means of transport)
  • Accountable (Quality service)
  • Achievable (Scope and resources)
  • Adaptable (Not resistant to change)
  • Appropriate (Infrastructure, Technology, Human resources)
• Categories of eye care workers


  • Full time – ophthalmologist, ophthalmic clinical officers, optometrist, ophthalmic assistant/nurses/technician, other ophthalmic paramedics
  • Integrated – General practitioners, Clinical officers, health workers, nurses, midwives, environmental health technician
  • Community – school teachers, social welfare, water department, village leaders/health workers
• Primary eye care equipment


  • Snellen E chart
  • Hand magnifying lens
  • Torch and batteries
  • Pin hole
  • Epilating forceps (in trachoma endemic areas)
  • Dressing: eye pads, bandages, sticking plaster, eye shield, cotton
  • Sprit
  • Notebook and ball pen
  • Information, Education and Communication (IEC)
• To have a successful primary eye care program, there needs to be coordinated teamwork
• There should be regular and interaction between the full-time eye workers and the volunteer eye workers
• The complementary nature of the teams needs to be understood and appreciated
• Task oriented training of all teams' members should be based on the skills that they need to acquire in which competence is necessary
• Ametropia


  Vision problem caused by the shape of the eye, which prevents light from focusing properly on the retina, leading to unclear vision

  
• Emmetropia


  Image from distance objects are formed at the (central) retina ('zero refractive error) (20-20 vision)

  
• Myopia


  Refractive error where distant objects appear blurry while close objects can be seen clearly. It occurs when the eyeball is too long or the cornea is too curved, causing light rays to focus in front of the retina instead of directly on it

  
• Reflection


  Occurs when light rays from sources strike objects, causing them to bounce off. Surfaces, typically rough upon close inspection, scatter light rays in various directions and angles. This bounced light is termed reflected light
• Myopia


  Form of refractive error inability to refract, bend focus the light ray properly in which parallel rays of light coming from a distinct object after entering the eye are focused in front of the retina instead of at the retina when accommodation/muscles are at rest

  
• Causes of myopia


  • Curvature
  • Axial length
  • Refractive index (or refraction index)
  • Positional

  
• Types of congenital myopia


  • Simple (5-10 years old)
  • Simple (15-20 years old)
  • Pathological (15-20 years old)
• Symptoms of myopia


  • Blurring of Vision
  • Half Shutting Eye or Squinting
  • Outward Deviation of Eyes
  • Retinal Changes
  • Prominent Eyeball

  
• Diagnosis of myopia


  • Retinoscopy
  • A-scan
• Non-surgical treatment of myopia


  • Decrease the Refracting Power
  • Diverging Lenses (Concave Lens)
  • Eyeglasses
  • Contact Lenses
  • Orthokeratology

  
• Surgical treatment of myopia


  • RK (Radial Keratotomy)
  • PRK (Photorefractive Keratectomy)
  • LASEK (Laser Epithelial Keratomileusis)
  • LASIK (Laser In Situ Keratomileusis)
  • Lens Extraction
• Hyperopia


  Refractive error characterized by the inability to refract, bend, and focus light rays properly, resulting in parallel rays of light from a distinct object focusing behind the retina instead of directly on it when the eye's accommodation muscles are at rest

  
• 3 components model of vision


  • Visual Efficiency
  • Visual integrity
  • Visual processing
• Cycloplegic refraction


  Specialized eye examination technique using cycloplegic eye drops to temporarily paralyze the eye's focusing muscles, known as the ciliary muscles, allowing accurate measurement of refractive error

  
• The extent to which a hyperope's distance vision can be improved by accommodation is limited only by the amplitude of accommodation
• Near visual acuity depends on the amount of hyperopia, the amplitude of accommodation, and the distance at which reading is attempted

  
• Individuals with hyperopia may experience


  • Blurred vision
  • Asthenopia (eye strain or discomfort)
  • Accommodative dysfunction
  • Binocular dysfunction
  • Amblyopia (lazy eye)
  • Strabismus (misalignment of the eyes)

  
• Two extremes of hyperopia


  • Refractive hyperopia: Normal axial length but longer focal length of the eye's optical system
  • Axial hyperopia: Shorter axial length but normal focal length of the optical system

  
• Causes of hyperopia


  • Axial length
  • Index (refractive index)
  • Positional
  • Aphakia (absence of the lens of the eye)